Destination Guide

Gabon

Capital: Libreville

Time Zone: +1 hour. GMT +2 from the last Sunday in March to last Sunday in October.Tel. Country Code: 241USADirect Tel.: 0Electrical Standards: Electrical current is 220/50 (volts/hz). European Style Adaptor Plug. Grounding Adaptor Plug D.

Travel Advisory - Gabon

Sub-Saharan Africa has the highest incidence of insect-transmitted diseases, such as malaria, and all travelers need products to prevent mosquito and tick bites. I recommend all travelers use a combination of DEET or Picaridin repellent on their skin and Permethrin fabric insecticide on their clothing for greater than 99% protection against mosquito and tick bites.

There is no British Embassy in Gabon. In an emergency, you can obtain consular assistance from the British Honorary Consul in Libreville. Otherwise, all enquiries should be made to the British High Commission in Yaoundé, Cameroon.

• British Honorary Consul in Libreville (Tel: [241] 769 899 during office hours; or [241] 0626 3994 at other times).

Entry Requirements

HIV Test: Not required.

Required Vaccinations: A yellow fever vaccination certificate is required from all travelers older than 1 year of age arriving from ALL COUNTRIES.

Passport Information

Passport/Visa: Gabon is a developing nation in west central Africa. French is the official language; few Gabonese speak English. Facilities for tourism outside the capital city, Libreville, are available, but they are often limited and can be expensive.

ENTRY/EXIT REQUIREMENTS: A passport and visa are required. Proof of yellow fever vaccination is required for entry. Visas must be obtained in advance, as airport visas are no longer available. Travelers should obtain the latest information and details from the Embassy of Gabon, 2034 20th Street NW, Washington, DC 20009, telephone: (202) 797-1000, fax: (202) 332-0668. Travelers may also contact the Gabonese Consulate at 18 East 41st St., Ninth Floor, New York, NY 10017, telephone (212) 683-7371. Overseas, inquiries should be made to the nearest Gabonese embassy or consulate.

Vaccinations: Recommended and Routine

Hepatitis A: Recommended for all travelers >1 year of age not previously immunized against hepatitis A.

Hepatitis B: Recommended for all non-immune travelers at potential risk for acquiring this infection. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from acupuncture, tattooing or body piercing; when receiving non-sterile medical or dental injections, or unscreened blood transfusions; by direct contact with open skin sores on an infected person. Recommended for long-term travelers, expatriates, and any traveler requesting protection against hepatitis B infection.

Influenza: Vaccination recommended for all travelers >6 months of age who have not received a flu shot in the previous 12 months.

Meningococcal (Meningitis): Quadrivalent conjugate meningitis vaccine is recommended for those travelers anticipating living or working closely with local people. The risk is greatest in the dry season, from November to May/June. Vaccination should be considered for all travelers venturing into epidemic regions at any time of year.

Polio: A one-time dose of IPV vaccine is recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult. Available data do not indicate the need for more than a single lifetime booster dose with IPV (Inactivated Polio Vaccine).

Rabies: Rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection.

Routine Immunizations: Immunizations against tetanus-diphtheria, measles, mumps, rubella (MMR vaccine) and varicella (chickenpox) should be updated, if necessary, before departure. MMR protection is especially important for any female of childbearing age who may become pregnant.

• In addition to tetanus, all travelers, including adults, should be fully immunized against diphtheria. A booster dose of a diphtheria-containing vaccine (Td or Tdap vaccine) should be given to those who have not received a dose within the previous 10 years. Note: ADACEL and Boostrix are new tetanus-diphtheria-pertussis (Tdap) vaccines that not only boost immunity against diphtheria and tetanus, but have the advantage of also protecting against pertussis (whooping cough), a serious disease in adults as well as children. The Tdap vaccines can be administered in place of the Td vaccine when a booster is indicated.

Typhoid: Recommended for all travelers with the exception of short-term visitors who restrict their meals to hotels or resorts.

Yellow Fever: Yellow fever vaccination is required for all travelers >1 year of age arriving from ALL COUNTRIES. Vaccination should be administered at least 10 days prior to arrival in order for the certificate of vaccination to be valid. Vaccination is recommended for all travelers >9 months of age.

Hospitals / Doctors

All travelers should be up-to-date on their immunizations and are advised to carry a medical kit as well as antibiotics to treat travelers diarrhea (high risk) or other infections (e.g., a urinary tract infection); they should bring drugs for malaria prophylaxis, if needed according to their itinerary. Travelers who are taking regular medications should carry them properly labeled and in sufficient quantity to last for the duration of their trip; they should not expect to obtain prescription or over-the-counter drugs in local stores or pharmacies in this country - the equivalent drugs may not be available; may be counterfeit; or be of unreliable quality. • Travelers are advised to obtain comprehensive travel insurance with specific overseas coverage, including air ambulance transport. In the event of a serious illness or injury that can't be treated locally, every effort should be made to arrange medical evacuation to Western Europe.

Most of the health services are public, but there are some private institutions, of which the best known is the hospital established in 1913 in Lambarene by Albert Schweitzer. The hospital is now partially subsidized by the Gabonese government.

Destination Health Info for Travelers

AIDS/HIV: Heterosexual contact is the predominate means of HIV transmission in Gabon. HIV prevalence in this country is estimated at >10% of the urban population and higher among commercial sex workers. The over-all HIV prevalence is 7.9% of adults age 15-49. (Source: www.Avert.org) • Transmission of HIV can be prevented by avoiding: sexual contact with a high-risk partner; injecting drug use with shared needles; non-sterile medical injections; unscreened blood transfusions. • The threat of HIV/AIDS should not be a primary concern for the traveler. However, there may be a concern for a subset of travelers who may be exposed to HIV, the virus that causes AIDS, through contact with the body fluids of another person or their blood. Although travel has contributed in a general way to the global spread of AIDS, fear of traveling because of this disease is not warranted.

Accidents & Medical Insurance: Accidents and injuries are the leading cause of death among travelers under the age of 55 and are most often caused by motor vehicle and motorcycle crashes; drownings, aircraft crashes, homicides, and burns are lesser causes. • Heart attacks cause most fatalities in older travelers. • Infections cause only 1% of fatalities in overseas travelers, but, overall, infections are the most common cause of travel-related illness. • Travelers are advised to obtain, prior to departure, supplemental travel health insurance with specific overseas coverage. The policy should provide for direct payment to the overseas hospital and/or physician at the time of service and include a medical evacuation benefit. The policy should also provide 24-hour hotline access to a multilingual assistance center that can help arrange and monitor delivery of medical care and determine if medevac or air ambulance services are required.

African Trypanosomiasis (Sleeping Sickness): Risk areas for sleeping sickness (trypanosomiasis) persist along the coast, primarily the Komo estuary around Libreville, and the mouth of the Ogooue River near Port Gentil. Travelers at most risk are those on safari and game-viewing holiday. Travelers to urban areas are at very low risk. The tsetse fly comes out in the early morning and the late afternoon. Insect repellent applied to the skin does not prevent tsetse fly bites, so travelers should wear protective clothing and sleep under a bed net. • Initial symptoms: The bite of tsetse fly can be painful and may develop into a raised red sore, called a chancre. The initial sore may subside or develop into an expanding red, tender, swollen area, followed by a generalized illness with fever, myalgia, abdominal discomfort, diarrhea, vomiting, headache, rigors, and sweats. Read more: hthttp://www.phac-aspc.gc.ca/tmp-pmv/info/af_trypan-eng.php

Chikungunya Fever: Outbreaks of this disease occur regularly. An outbreak of chikungunya virus was reported in April 2010 in south-eastern Gabon, in the region of Ogooue-Lolo and late April in the Haut-Ogooue, Franceville, which is the county seat. An outbreak of chikungunya fever was also reported in May 2007 from Libreville, the capital of Gabon. There have also been reports of outbreaks in the southern suburb of Owendo on the Gabon Estuary. • Chikungunya virus is an alphavirus closely related to the viruses that cause eastern equine encephalitis and western equine encephalitis. The disease is transmitted by daytime-biting Aedes aegypti and Aedes albopictus mosquitoes. There are no specific treatments for Chikungunya. There is no vaccine currently available. Infection . Symptoms: The Chikungunya virus causes a debilitating illness, most often characterized by fever, headache, fatigue, nausea, vomiting, muscle pain, rash, and joint pain • All travelers should exercise insect-bite prevention measures. These measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear. DEET-based repellents remain the gold standard of protection under circumstances in which it is crucial to be protected against mosquito bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing. Note: Sleeping under a permethrin-treated bednet will help prevent bites by the malaria-transmitting Anopheles mosquitoes.

Cholera: This disease is reported active in this country, but the threat to tourists is very low. Cholera vaccine is recommended only for relief workers or health care personnel who are working in a high-risk endemic area under less than adequate sanitary conditions, or travelers who work or live in remote, endemic or epidemic areas and who do not have ready access to medical care. Canada, Australia, and countries in the European Union license an oral cholera vaccine. The cholera vaccine is not available in the United States. • The main symptom of more severe cholera is copious watery diarrhea. • Antibiotic therapy is a useful adjunct to fluid replacement in the treatment of cholera by substantially reducing the duration and volume of diarrhea and thereby lessening fluid requirements and shortening the duration of hospitalization. • A single 1-gm oral dose of azithromycin is effective treatment for severe cholera in adults. This drug is also effective for treating cholera in children. (NEJM:http://content.nejm.org/cgi/content/short/354/23/2452)

Dengue Fever: Dengue fever is a mosquito-transmitted, flu-like viral illness occurring in many parts of sub-Saharan Africa. Symptoms consist of sudden onset of fever, headache, muscle aches, and a rash. A syndrome of hemorrhagic shock can occur in severe cases. • Dengue is transmitted via the bite of an infected Aedes aegypti mosquito. Aedes mosquitoes feed predominantly during daylight hours. All travelers are at risk and should take measures to prevent daytime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin and applying permethrin spray or solution to clothing and gear. • There is no vaccination or medication to prevent or treat dengue.

Ebola Virus Hemorrhagic Fever: Viral hemorrhagic fever has been previously reported in Ogooue Ivindo Province in the northeastern part of the country. The Ebola virus is acquired by direct contact with the body fluids or secretions of infected or deceased patients. It is not transmitted by insect bites. The risk to travelers is low.

Hepatitis: All travelers not previously immunized against hepatitis A should be vaccinated against this disease. Travelers who are non-immune to hepatitis A (i.e. have never had the disease and have not been vaccinated) should take particular care to avoid potentially contaminated food and water. Travelers who will have access to safe food and water are at lower risk. Those at higher risk include travelers visiting friends and relatives, long-term travelers, and those visiting areas of poor sanitation. • Hepatitis E is endemic but levels are unclear. Sporadic cases and outbreaks occur but may go underdiagnosed or unreported. Transmission of the hepatitis E virus (HEV) occurs primarily through drinking water contaminated by sewage and also through raw or uncooked shellfish. In developing countries, prevention of hepatitis E relies primarily on the provision of clean water supplies and overall improved sanitation and hygiene. There is no vaccine. • Hepatitis B is hyperendemic. The overall hepatitis B (HBsAg) carrier rate in the general population is estimated at >8%. Hepatitis B is transmitted via infected blood or bodily fluids. Travelers may be exposed by needle sharing and unprotected sex; from non-sterile medical or dental injections, and acupuncture; from unscreened blood transfusions; by direct contact with open skin lesions of an infected person. The average traveler is at low risk for acquiring this infection. Vaccination against hepatitis B is recommended for: persons having casual/unprotected sex with new partners; sexual tourists; injecting drug users; long-term visitors; expatriates, and anybody wanting increased protection against the hepatitis B virus. • Hepatitis C is endemic at high level, with a prevalence of 6.5% in the general population. Most hepatitis C virus (HCV) is spread either through intravenous drug use or, in lesser-developed countries, through blood contamination during medical procedures. Over 200 million people around the world are infected with hepatitis C - an overall incidence of around 3.3% of the population of the world. Statistically, as many people are infected with HCV as are with HIV, the virus that causes AIDS.

Influenza: Influenza is transmitted year-round in the tropics. The flu vaccine is recommended for all travelers over age 6 months.

Loiasis: High risk present in the southeastern rain forest and swamp forest. Infection rate of 25% reported in the Franceville vicinity. Travelers should take measures to prevent insect (deer fly) bites.

Malaria: Risk is present year-round, countrywide, including urban areas. Risk is elevated during and immediately after the rainy seasons (October through December and February through April). Falciparum malaria accounts for 95% of cases. Chloroquine-resistant falciparum malaria is reported. • Prophylaxis with atovaquone/proguanil (Malarone), mefloquine (Lariam), doxycycline or primaquine (G6PD test required) is recommended.

A malaria map is located on the Fit for Travel website, which is compiled and maintained by experts from the Travel Health division at Health Protection Scotland (HPS). Go to www.fitfortravel.nhs.uk and select Malaria Map from the Gabon page on the Destinations menu or A-Z Index.

Malaria is transmitted via the bite of an infected female Anopheles mosquito. Anopheles mosquitoes feed predominantly during the hours from dusk to dawn. All travelers should take measures to prevent evening and nighttime mosquito bites. Insect-bite prevention measures include applying a DEET-containing repellent to exposed skin, applying permethrin spray or solution to clothing and gear, and sleeping under a permethrin-treated bednet. DEET-based repellents have been the gold standard of protection under circumstances in which it is crucial to be protected against insect bites that may transmit disease. Nearly 100% protection can be achieved when DEET repellents are used in combination with permethrin-treated clothing. NOTE: Picardin repellents (20% formulation, such as Sawyer GoReady or Natrapel 8-hour) are now recommended by the CDC and the World Health Organization as acceptable non-DEET alternatives to protect against malaria-transmitting mosquito bites. Picaridin is also effective and ticks and biting flies. • You should consider the diagnosis of malaria if you develop an unexplained fever during or after being in this country. • Long-term travelers who may not have access to medical care should bring along medications for emergency self-treatment should they develop symptoms suggestive of malaria, such as fever, chills, headaches, and muscle aches, and cannot obtain medical care within 24 hours.

Onchocerciasis: Also known as river blindness. Widely distributed, especially in Ndjole, Fougamou, Mimongo, Lebamba, Latoursville, and Makokou. Travelers should take measures to prevent insect (blackfly) bites.

Poliomyelitis (Polio): Polio remains persistent in sub-Saharan Africa. All travelers should be fully immunized. A one-time dose of IPV (Inactivated Polio Vaccine) is recommended for any traveler >age 18 who completed the primary childhood series but never received an additional dose of polio vaccine as an adult.

Rabies: Sporadic cases of human rabies are reported countrywide. All animal bites or scratches, especially from a dog, should be taken seriously and immediate medical attention sought. Rabies vaccination may be required. This may require medical evacuation to another country if rabies vaccine and rabies immune globulin are not available. Although rabies is rare among tourists there is risk. No one should pet or pick up any stray animals. All children should be warned to avoid contact with unknown animals. Pre-exposure rabies vaccine is recommended for: persons anticipating an extended stay; for those whose work or activities may bring them into contact with animals; for people going to rural or remote locations where medical care is not readily available; for travelers desiring extra protection. Children are considered at higher risk because they tend to play with animals and may not report bites. •Pre-exposure vaccination eliminates the need for rabies immune globulin, but does not eliminate the need for two additional booster doses of vaccine. Prompt medical evaluation and treatment of any animal bite is essential, regardless of vaccination status.

Schistosomiasis: Foci of disease are scattered throughout all provinces, with a major focus in the Libreville area. Schistosomiasis is transmitted through exposure to contaminated water while wading, swimming, and bathing. Schistosoma larvae, released from infected freshwater snails, penetrate intact skin to establish infection. • All travelers should avoid swimming, wading, or bathing in freshwater lakes, ponds, streams, cisterns, aqueducts, or irrigated areas. There is no risk in chlorinated swimming pools or in seawater.

Travelers' Diarrhea: High risk. Piped water supplies in Libreville, Port-Gentil, and Bata may be grossly contaminated. Water-borne and food-borne diseases are prevalent with more serious outbreaks occurring from time to time. Outbreaks of diarrheal diseases are common during the rainy season. Outside of hotels and resorts, we recommend that you boil, filter or purify all drinking water or drink only bottled water or other bottled beverages and do not use ice cubes. Avoid unpasteurized dairy products. Do not eat raw or undercooked food, especially meat, fish, raw vegetables. Peel all fruits. • Good hand hygiene reduces the incidence of travelers’ diarrhea by 30%. • A quinolone antibiotic, or azithromycin, combined with loperamide (Imodium), is recommended for the treatment of diarrhea. Diarrhea not responding to antibiotic treatment may be due to a parasitic disease such as giardiasis, amebiasis, or cryptosporidiosis. • Seek qualified medical care if you have bloody diarrhea and fever, severe abdominal pain, uncontrolled vomiting, or dehydration.

Tuberculosis: Tuberculosis is highly endemic in Gabon with an annual occurrence was greater than or equal to 40 cases per 100,000 population. Tuberculosis (TB) is transmitted following inhalation of infectious respiratory droplets. Most travelers are at low risk. Travelers at higher risk include those who are visiting friends and relatives (particularly young children), long-term travelers, and those who have close contact, prolonged contact with the local population. There is no prophylactic drug to prevent TB. Travelers with significant exposure should have PPD skin testing done to evaluate their risk of infection.

Typhoid Fever: Typhoid fever is the most serious of the Salmonella infections. Typhoid vaccine is recommended by the CDC for all people traveling to or working in sub-Saharan Africa, especially if visiting smaller cities, villages, or rural areas and staying with friends or relatives where exposure might occur through food or water. Current vaccines against Salmonella typhi are only 50-80% protective and do not protect against Salmonella paratyphi, the cause of paratyphoid fever. (Paratyphoid fever bears similarities with typhoid fever, but the course is generally more benign.) Travelers should continue to practice strict food, water and personal hygiene precautions, even if vaccinated.

Yellow Fever: Yellow fever is reported from Ogooue-Invindo Province, but there is a risk of yellow fever transmission in all areas of this country. • A yellow fever vaccination certificate is required for all travelers >1 year of age to enter this country. Vaccination is recommended also for travelers between the ages of 9 and 12 months.